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Digestive System and Drug Therapy消化系统与药物治疗
误诊案例——
一位七十岁农村患者，慢性腹痛、贫血、粪便 潜血阳性，多家医院反复检查胃镜、肠镜，诊 断为消化性溃疡或肠癌，按消化性溃疡治疗无 效，未见肿瘤证据或扩散迹象……
最后诊断钩虫病 简单的粪便检查（24%饱和盐水实验）可发现钩 虫卵
飞机上乘客发作的胆绞痛，胃痛
Pharmacology of gastric acidity, peptic ulcers, and gastroesophageal reflux disease 消化性溃疡与胃食管返流性疾病特点
The acid-peptic diseases are those disorders in which gastric acid and pepsin are necessary, but usually not sufficient, pathogenic factors. While inherently caustic, acid and pepsin in the stomach normally do not produce damage or symptoms because of intrinsic defense mechanisms.
消化性溃疡（peptΒιβλιοθήκη Baiduc ulcer）
胃十二指肠溃疡特点 慢性 复发性
粘膜防御/修复功能受损 应激与损害粘膜的各类
侵袭因子
✓ 胃酸、胃蛋白酶、非甾体类 抗炎药(NSAIDs) 等损伤,皮 质激素，交感神经-肾上腺 系统兴奋 应激举例:考试
✓ 幽门螺杆菌感染
抗消化性溃疡药
碱性抗酸药（中和胃酸药） 抑制胃酸分泌药 ✓ H2 受体阻断药 ✓ 胃壁细胞质子泵（H＋ -K＋-ATP酶）抑制剂 ✓ M胆碱受体阻断药 粘膜保护剂 抗幽门螺杆菌药
The treatment and prevention of these acid-related disorders are accomplished either by decreasing the level of gastric acidity or by enhancing mucosal protection.
Therapies are directed at decreasing gastric acidity, enhancing the lower esophageal sphincter, or stimulating esophageal motility.
Pharmacology of gastric acidity, peptic ulcers, and gastroesophageal reflux disease 消化性溃疡与胃食管返流性疾病特点
In the stomach, mucus and bicarbonate, stimulated by the local generation of prostaglandins, protect the gastric mucosa. If these defenses are disrupted, a gastric or duodenal ulcer may form.
Optimal therapeutic decisions are based on an evaluation of the individual patient in concert with assessment of the evidence for efficacy and safety of the treatment under consideration. An understanding of the pharmacokinetics and pharmacodynamics of the drug should be integrated with this patient-focused information to guide implementation of therapy. 理解患者疾病 熟悉药物特性
Barriers to the reflux of gastric contents into the esophagus comprise the primary esophageal defense. If these protective barriers fail and reflux occurs, dyspepsia and/or erosive esophagitis may result.
消化系统解剖与功能特点复习
GI
消化系统疾病特点与治疗药物
解痉药止痛药 胃食管反流病治疗 消化性溃疡治疗 消化道止血药 消化功能调节药 泻药与止泻药 止吐药与催吐药 炎症性肠病用药 感染与肝胆胰疾病用药
解痉(止痛)药－M受体阻断药
*阿托品* • 松弛平滑肌 ✓ 解除胃肠胆道平滑肌痉挛引起的疼痛 ✓ 止吐 • 作用广泛，选择性低，副作用较多 • 制剂：口服、肌肉注射 *山莨菪碱（654-2）* • 替代阿托品用于解痉止痛
不同系统疾病诊治，有其生理解剖与病理基 础特点，应根据患者症状、体征，具体问题
选择相应类型药物，标本兼治
千万别那样
The Science of Drug Therapy
Drug therapy affords an expanding opportunity for preventing and treating disease and for alleviating symptoms. Pharmacologic agents also expose patients to risk. Basic principles of drug therapy provide a conceptual framework for deploying drugs with maximal efficacy while minimizing the risk of adverse effects.努力提高疗效 同时减少损害
